An assistant at Bewick Lodge Care Home in Lemington, Newcastle, has pleaded guilty to yanking the hair of an eighty-nine-year-old dementia victim and drenching her in water. He has been given a community order and told to pay fifty pounds in compensation to his victim. Perhaps this eighty-nine-year-old is made of strong stuff but I doubt that a few tenners will make up for such pain, fear and disorientation. It’s barely enough to make up for a stubbed toe.
The man had been dismissed from a previous care home job after directing abusive, threatening language towards residents, and is said to endure Asberger syndrome. It is a depressing indictment of our system that a man who not only lacks communication skills and empathy but had demonstrated that he is so deficient in these virtues that he could threaten elderly people was charged with caring for disabled octogenarians. What on earth did they expect when they employed the man?
I have been writing notes on this subject since the Winterbourne View scandal in 2011, which saw Panorama expose widespread abuse at a care home near Bristol. “Never again” was the cry that went up in the aftermath of the programme. It is worth reflecting on the issue at greater length both because it has happened again and because the inadequate official response will ensure that it continues to happen again. And again. Et cetera.
Britain’s social care system has been expanding and will continue to expand as more people live longer lives and require greater support. Governments have failed to explore and promote means of maintaining the health and independence of the ageing, which could both improve their lives and ameliorate the risk of soaring costs, yet it remains unavoidable that millions will need care.
The system is inconsistent, and provides very good and very bad services, but it would not be unjust to give the broad assessment that we do not seem concerned with giving the aged and the disabled the best quality of life that could be reasonably offered them. (Thousands of old people, for example, seem to be given antipsychotic drugs that do no good to them and endanger their health because they shut them up.) What should be unarguable – the baseline from which standards of care could be devised – is that no one, least of all people who age or disabilities have made frail and sensitive, should be subjected to violence and intimidation.
It sounds obvious yet to many people it might come as something of a revelation. According to the Care Quality Commission, tens of thousands of people are reported to have faced abuse and neglect each year. These can represent cases of petty spite, such as when a thug in Staffordshire took it upon himself to shout “boo” in an old woman’s face, or dramatic violence. One male nurse was filmed striking an eighty-year-old victim of Alzheimer’s disease.
This phenomenon is representative not just of rotten apples but a rotten orchard. Most care workers are, of course, decent and assiduous people who have taken on a job that, when performed correctly, is rather more difficult than most. Yet the low, indeed almost non-existent standards by which one can acquire and maintain such a job have attracted far too many of the angry, irritable and unintelligent men and women who are least capable of performing its duties.
Staff of the questionable character of the assistant at Bewick Lodge have also been allowed to lodge themselves within the system. According to the NHS Information Centre, five percent of suspects in reported cases of abuse have faced the sack while one percent have been referred to watchdogs to investigate whether they should be excluded from their profession. These are, of course, reported cases, and many of the suspects would have been innocent, yet stories such as that emerging from Lemington suggest that others have been guilty yet somehow clung to their careers. This is disgraceful. The abusive should enjoy no “…strikes and you are out” rule.
The government plans to introduce compulsory training for care home staff. On Question Time in 2011 a mild-mannered representative of Plaid Cymru observed that minimal training could have been a factor in the Winterbourne View scandal. He was mocked by a collection of knee-jerking ninnyhammers – which included Stephen Dorrell, the Conservative MP – for supposedly implying that abusers only have to be told not to bully people. His actual point, as the government seems to be acknowledging almost two years later, was that if greater demands are made of applicants the worst of them may not apply.
It would have been nice if the Conservatives had paused to reflect on this before all of the scandals of the last twenty-two months. (Perhaps they can grant that Plaid Cymru were well ahead of them.) Still, we can hope that it is true, and that more training will also lead nurses and care workers to be more sensitive to unconscious incidents of neglect or offence that they could have made through ignorance rather than malice. Much of it depends, perhaps, on whether lessons of Mid Staffordshire have been internalised; on carers being trained to care rather than to meet targets.
To demand more training of care workers seems both inadequate and unfair if it is not accompanied by better salaries. In 2009, Andy Burnham, who was enjoying a brief spell as health secretary, admitted that the social care workforce was “in many ways underpaid”, which had led to “pressure” and ensured that “the quality in some parts [wa]sn’t there”. This is not a man to be charged with stridency. In opposition, the ever unhelpful Labour Party has failed to raise even these mildest of observations. Under the Conservatives and Liberal Democrats, meanwhile, amid enthusiastic cost-cutting and privatisation, thing have worsened rather than improved. According to Heather Wakefield of UNISON, more than half of Britain’s care employees have seen their wages decline, despite taking on additional duties.
These miserable rates of pay dissuade good people from applying and attract men and women who are unstable or aggressive enough that they could find nothing else to do. Conscientious employees, meanwhile, have their fine work go unrewarded, and may be so frustrated as to let their standards drop. The worst are enabled while the best are handicapped, and the old and disabled suffer the effects of both.
It is obvious that as millions of men and women shuffle into the social care system its jobs will be too numerous and accessible to be among the most high status of careers. It would enrage us if so little was expected of or given to the people who teach our children or treat our illnesses, though, and I am unsure of the difference here beyond the fact that the victims are too weak to complain about it. Either the money is to be found among our budgets, and the worst profit-seeking habits of private institutions curbed, or we might as well admit to being tolerant of high levels of violence and neglect perpetrated against the weakest among us.
Some of the abusers, though, have been the bosses, not the staff. Their little tyrannies have been preserved by a system that fails to expose abuse or protect whistleblowers who reveal it. Cynthia Bower, the head of the Care Quality Commission, stepped down last year amid justifiable suggestions that the watchdog was a blind old mutt. Citizens who lead the state to crimes, meanwhile, have so little support that many people must have been dissuaded from coming forward. Eileen Chubb, who lost her job after exposing abuse in her workplace, says she was blacklisted by every care home in her area. Now head of the charity Compassion in Care, she argues that legislation “is so badly written that whistleblowers don’t stand a chance”. This must change, or the voiceless will have no one to speak for them.
One might as well end by observing some of the cases that have been exposed or heard in court in the first months of a young 2013. A care worker in Truro seized an autistic man and slammed his head into a door. A nurse in Rosgrove was charged with pushing a woman outside in her nightdress and leaving her to freeze. A nurse in Wales was struck off after spitting, shouting and swearing at residents. Snap inspections have revealed numerous cases of neglect in care homes and hospitals across Britain, including that of an old woman who did not seem to have drunk water in more than half a week.
This is one of those hard problems that defies convenient solutions but that only makes forming a serious response a task of greater urgency. Millions of people, as things stand, will be saved from death to lives in fear and isolation. Such cases as those I have noted, investigators say, probably represent the “tip of the iceberg”.